Evidence for an effect of ACE inhibitors on cancer cachexia.

Dear Editor,

In a recent review article by Trobec et al., it was stated that there are no data on the effects of ACE inhibition in the field of cancer cachexia, even though there is some evidence for a beneficial effect on muscle mass in chronic heart failure, i.e. cardiac cachexia [1]. While it is true that there are no PubMed-listed clinical studies, Ark Therapeutics has completed a phase III clinical trial on the use of imidapril in non-small cell lung cancer (NSCLC), colorectal cancer and pancreatic cancer which showed significant reduction in the rate of weight loss in both NSCLC and colorectal cancer but not in pancreatic cancer. However, when analyzed together, the significance on weight loss reduction was lost and hence the trial missed its primary endpoint [2]. These results prompted a second phase III trial in August 2008, which was focused on NSCLC [3]. However, due to a commercial refocusing, Ark Therapeutics is no longer pursuing this study. Furthermore, there is evidence from pre-clinical models that ACE inhibition can indeed reduce wasting of muscle mass in cancer cachexia [4]. Taken together, there are some data—albeit limited—on the usefulness of ACE inhibition in cancer cachexia.